Caries: Tooth Decay

Dental caries (colloquially tooth decay) (synonyms: caries; dental caries; enamel caries; cementum caries; dental caries; tooth decay; ICD-10-GM K02.-: Dental caries) is a progressive (advancing), gradual destruction of the various tooth hard tissues. It is one of the most widespread bacterial infectious diseases worldwide. Caries has been recorded in Egyptian mummies, in ancient Greeks and Romans, and in people of the Middle Ages. Its prevalence was lower than today, but increased over time. In the Middle Ages, 25% of teeth were already affected.The increase in caries is attributed to changes in the diet, which in the past was often rich in fibers and contaminated. People showed severe abrasion (loss of tooth structure), which resulted in the loss of fissures (pits in the occlusal relief of the posterior teeth) as surfaces for caries to attack. At that time, the most frequent caries was found in the neck of the tooth.In the course of time, the diet was refined. It was purer and now also richer in carbohydrates. As a result, on the one hand, the self-cleaning effect that existed due to the high-fiber diet was lost and the sugars had a negative effect on caries.One can conclude from the historical data that caries is a disease of civilization that is directly related to the changes in dietary habits.The geographical distribution of caries has also been investigated in studies. A higher prevalence was found in temperate latitudes than in areas with warmer climates. However, this need not be purely climatic, but higher energy requirements may be met by carbohydrate-rich foods and thus promote caries.Consequently, studies have been conducted on the role of trace elements in the spread of caries. It has been shown that the fluorine content in drinking water is an important factor. The so-called “point of maximum health” is 1 mg of fluorine per liter of drinking water. In this range, the caries risk and at the same time that of fluorosis are low.Other trace elements such as lithium or vanadium are associated with low caries prevalence, copper or lead with high caries prevalence. For caries to develop and begin its destructive work, various conditions must coincide (multifactorial event). The severity of the disease and tooth destruction is modulated by different risk factors. Many of these factors vary in degree from patient to patient and can be influenced by the patient or the treating dentist. Therefore, the risk of developing caries varies from person to person (so-called “individual caries risk”).Gender ratio: women suffer from caries more frequently than men in relation to permanent teeth.Frequency peak: the following relationship exists between caries and age: 14- to 16-year-olds show high caries activity. If this caries remains untreated, it can develop into clinical caries around the age of 20. Root caries is more likely to occur in the second half of life. The increase in caries with age can be demonstrated up to the age of 70-79 years. The lifetime prevalence (disease incidence throughout life) is close to 100% (in Europe). The prevalence (disease incidence) for caries freedom is 1% of adults (in Germany). 70.1 % of children under 12 years and 46.1 % of adolescents (15 years) are caries-free.Course and prognosis: Caries can be stopped if detected and treated early. If caries has already partially or completely destroyed teeth, the dentist has therapy options appropriate to the clinical picture to free teeth from caries and remove damage or replace teeth that have already been destroyed.Caries can lead to inflammation of the pulp (tooth pulp), abscesses (encapsulated accumulation of pus) and osteomyelitis (infectious inflammation of the bone marrow). Caries can be recurrent (recurring) (secondary caries). The margins of fillings and crowns are particularly susceptible to recurrence of caries if dental care is inadequate.